SciELO - Scientific Electronic Library Online

vol.31 issue2Municipal distribution of the incidence of the most common tumours in an area with high cancer mortalityNew birthweight charts according to parity and type of delivery for the Spanish population author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand




Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google


Gaceta Sanitaria

Print version ISSN 0213-9111


PEREZ-ROMERO, Carmen; ORTEGA-DIAZ, M. Isabel; OCANA-RIOLA, Ricardo  and  MARTIN-MARTIN, José Jesús. Analysis of the technical efficiency of hospitals in the Spanish National Health Service. Gac Sanit [online]. 2017, vol.31, n.2, pp.108-115. ISSN 0213-9111.


To analyse the technical efficiency and productivity of general hospitals in the Spanish National Health Service (NHS) (2010-2012) and identify explanatory hospital and regional variables.


230 NHS hospitals were analysed by data envelopment analysis for overall, technical and scale efficiency, and Malmquist index. The robustness of the analysis is contrasted with alternative input-output models. A fixed effects multilevel cross-sectional linear model was used to analyse the explanatory efficiency variables.


The average rate of overall technical efficiency (OTE) was 0.736 in 2012; there was considerable variability by region. Malmquist index (2010-2012) is 1.013. A 23% variability in OTE is attributable to the region in question. Statistically significant exogenous variables (residents per 100 physicians, aging index, average annual income per household, essential public service expenditure and public health expenditure per capita) explain 42% of the OTE variability between hospitals and 64% between regions. The number of residents showed a statistically significant relationship. As regards regions, there is a statistically significant direct linear association between OTE and annual income per capita and essential public service expenditure, and an indirect association with the aging index and annual public health expenditure per capita.


The significant room for improvement in the efficiency of hospitals is conditioned by region-specific characteristics, specifically aging, wealth and the public expenditure policies of each one.

Keywords : Efficiency; Data envelopment analysis; Malmquist index; Multilevel analysis; National Health Service; Hospitals.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )